Transplant associated infections

Question 1

Solid organ transplant associated infections

Answer 1

infection in the organ transplant patient is determined by the synergy between two factors: the epidemiologic exposures of the individual and the “net state of immunosuppression,”

Question 2

CMV and EBV

Answer 2

Viral infections such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are associated with particular syndromes and morbidity in the immunocompromised population. The greatest risk for invasive infection is seen in recipients who are seronegative (immunologically naive) and receive infected grafts from seropositive donors (latent viral infection). This risk constitutes the rationale for anti-CMV prophylaxis in such patients.

non specific febrile illness

Question 3

infections 1 to 6 months after transplatation

Answer 3

●Pneumocystis jirovecii  pneumonia (PCP)
●toxoplasmosis, leishmaniasis, and Chagas disease
●Hepatitis B
●Hepatitis C
●Herpes zoster
●BK

Question 4

Infections less than 1 month after transplant

Answer 4

Mainly nosocomial and surgical site related

• S. aureus
• C.dif
• Candida

Question 5

Greater than 6 months after transplant

Answer 5

EBV
community acquired pneumonias
UTIs

Question 6

Post transplant lymphoproliferative disease

Answer 6

Post-transplant lymphoproliferative disorders (PTLD) are lymphoid and/or plasmacytic proliferations that occur in the setting of solid organ or allogeneic hematopoietic cell transplantation as a result of immunosuppression

pathogenesis of PTLD in most patients appears to be related to B cell proliferation induced by infection with Epstein-Barr virus (EBV)

Febrile
lymph node masses

PTLD is the most common malignancy complicating solid organ transplantation (excluding nonmelanoma skin cancer and in situ cervical cancer)

Question 7

Infections post stem cell transplant

Answer 7

Early <30 days
HSV
Strep
Candida
Aspergillus

30 to 100 days
CMV
EBV
PCP
Candida

Late >100 days
VSV
pneumococcus